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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />WC 99 06 43 <br />BLANKET NOTIFICATION TO OTHERS OF CANCELLATION OR NONRENEWAL ENDORSEMENT <br />This endorsement adds the following to Part Six of the policy. <br />PART SIX <br />CONDITIONS <br />Blanket Notification to Others of Cancellation or Nonrenewal <br />1. If we cancel or non -renew this policy by written notice to you, we will mail or deliver notification that such <br />policy has been cancelled or non -renewed to each person or organization shown in a list provided to us by <br />you if you are required by written contract or written agreement to provide such notification. However, such <br />notification will not be mailed or delivered if a conditional notice of renewal has been sent to you. Such list: <br />a. Must be provided to us prior to cancellation or non -renewal; <br />b. Must contain the names and addresses of only the persons or organizations requiring notification that <br />such policy has been cancelled or non -renewed; and <br />c. Must be in an electronic format that is acceptable to us. <br />2. Our notification as described in Paragraph 1. above will be based on the most recent list in our records as of <br />the date the notice of cancellation or non -renewal is mailed or delivered to you. We will mail or deliver such <br />notification to each person or organization shown in the list: <br />a. Within seven days of the effective date of the notice of cancellation, if we cancel for non-payment of <br />premium; or <br />b. At least 30 days prior to the effective date of: <br />(1) Cancellation, if cancelled for any reason other than nonpayment of premium; or <br />(2) Non -renewal, but not including conditional notice of renewal. <br />3. Our mailing or delivery of notification described in Paragraphs 1. and 2. above is intended as a courtesy only. <br />Our failure to provide such mailing or delivery will not: <br />a. Extend the policy cancellation or non -renewal date; <br />b. Negate the cancellation or non -renewal; or <br />c. Provide any additional insurance that would not have been provided in the absence of this endorsement. <br />4. We are not responsible for the accuracy, integrity, timeliness and validity of information contained in the list <br />provided to us as described in Paragraphs 1. and 2. above. <br />All other terms and conditions of this policy remain unchanged. <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br />(The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br />Endorsement Effective <br />Insured <br />Policy No. Endorsement No. <br />WC 1857087-02 Premium$ <br />Insurance Company <br />ZURICH AMERICAN INSURANCE COMPANY <br />,„ �, klvle Dlvidnn <br />APP <br />WC 99 �� Ra�nEveo&aovsro BP(Ed. 01-13) Includes copyright material of the National Council on Compensation Insurance, Inc. used with it "ll 3 <br />0 2012 Copyright National Council on Compensation Insurance, Inc All Rghts Roa RNkmanagement Supervrior <br />